Someone at work pointed to me this TED talk on changing the healthcare model. Some very good ideas in here, as well as the great presentation delivery which is a characteristic of TED. This type of forward thinking is unfortunately missing from the national efforts on “reform”.

It is very difficult to feel like our representative government actually represents us using a collection of popular and expert opinion when their statements on a topic are clearly motivated by a politically driven agenda.

In response to a question about whether a public plan option would lead to rationing, HHS Secretary Kathleen Sebelius said, “Care, unfortunately, is being rationed right now.”

The term “ration” implies an equal amount is given to each person. Care is not “rationed” now, it is financially constrained. Our personal limits on healthcare spending are currently limited by statistically driven price controls in insurance contracts, professional medical decisions, and our personal resources. A public option would replace the first limit, and possibly the second limit, with government policy. To consider that this policy would not be influenced by the special interests that currently have created our existing healthcare misalignment is to ignore human nature and history.

More to the point, we see how the words are being selected to sway opinion and not to collect opinion to form public policy. Since we all have our personal complaints about how we receive healthcare, regardless of current utilization and state of health, the noise and chaos allows influence peddling to become law without anyone comprehending what we are getting into. Or, at least try these expansions of existing healthcare spending in pilot programs which can be rejected when they don’t do anything.

By the way, David Blumenthal’s statement later in the article shocks the privacy nerve in not rejecting strongly the notion of a central federal database for medical records. Technical impossibility aside, nothing would create demand for opting-out of medical records more than central federal control.

This was the gossip at a concert we went to the other night. I remember thinking “please let it be his right hand, please let it be his right hand”.

No such luck – left hand. However, all seems to be well and the article has the detail on somewhat amazing diagnosis, surgery, and recovery on what was most likely career-ending not too long ago. Best of luck, Eddie!

There is obviously a lot at stake in the government’s current efforts to reform healthcare. Healthcaare contains the constant moral dilemma of balancing resources with life, and also represents a huge percentage of economic activity that has its associated special interests. Given that half of the spending in healthcare is currently controlled by the government guarentees that the decisions made will be the least common demoninator resulting from political compromise – or worse – a step backwards based on politiical self-interest.

Like many, I watched the beginning of this discussion with great optimism that some real reform would take place. I have even spent a measurable percentage of my time (and more specifically my company’s time) participating in various programs for public input and advocacy, so a lot of the details are well understood. But, I am becoming increasingly disappointed in the direction of the evolving legislation. While the goals of expanding coverage are admirable and ultimately necessary, the path to get there is now looking more like 1960’s thinking and not 21st century thinking. Back office agreements with the current system beneficiaries, fiscal manipulation, increased taxes, and retention of the current structure of employers, insurance, and claims. All done under a forced deadline which will make sure that whatever we get is anything available before the deadline and not what is the right thing to do. Add in a big effort to push the purchase of computer systems built on last centuries approach to healthcare (and largely rejected by physicians as useful for their work) to make sure we don’t move the infrastructure forward.

Let’s stop calling this reform and start calling this healthcare expansion under the current structure – a structure we know doesn’t work. Anything that preserves the fee-for-service backbone is a vote for non-reform. Solving the model of healthcare payment should be figured out before we even get into the debate of where to sit on the spectrum of nationalizing healthcare.

How about this: run any number of pilot projects that use a medical home model, primary care focus, community clinic focus, or anything that provides a market incentive for wellness. And include incentives for the average patient to take responsibility for their own health. And separate us from our employers so we have some idea what healthcare actually costs. Publish the results of the pilots to figure out the best practices. Here’s a great source for the pilot programs: use any of the existing federal programs.

It’s arguing that the federal investment in healthcare IT directly to EMR adoption is good but won’t create “reform” in healthcare (agreed). But an investment in telehealth and patient centric – read “self managed” – control of chronic conditions will reform healthcare (unknown). The authors feel market forces are against an effort in support of telehealth since it will reduce the need for encounters, which is the current revenue driver for healthcare – and the thing most in need of reform.